Wednesday, July 21, 2010

Belshaw's World - true wisdom rarely the sum of bland numbers

This is the first of a two part series.

I wonder how many Armidale people know just how important the University of New England was in providing the past intellectual firepower that allowed us to challenge conventional wisdom on country and regional issues?

I mention this because an email exchange with John Pigrim on UNE work triggered the need to explain why Government as presently structured so often fails the needs of people in general and country people in particular.

As a teenager, I believed that there was something of a plot against country people, that things were weighted against us.

The majority was in Sydney. So long as Sydney controlled things, we must be disadvantaged.

There was and is some truth in this. However, it wasn’t until I started working inside the system that I realised that the institutional structures themselves worked against the type of results I wanted.

This is best illustrated by examples. I have disguised them to avoid identifying specific agencies. Aged care should not necessarily be read as aged care.

Cash is short. All Government agencies have to set priorities.

Say you are dealing with aged care. You look at data and set priorities for the State as a whole. This means focussing on areas of greatest need. However, this can create local problems.

Take a small country town that has raised money for an age care facility. It wants a small grant to complete the project, a grant that offers a very high rate of return measured by contribution to aged care. The government gets $10 for every $1 of state funds, far higher than most equivalent projects. The application is rejected on priority grounds, even though the need is there.

In setting priorities, is not just the relative need that is important, but also the cost of delivering services and the standard of care.

Like aged care, the health service is short of funds. Further, it faces rapidly rising costs, along with growing demand for increasingly complex services. To manage this, it centralises services, withdrawing services from certain country towns.

We now have a double whammy.

Assume that the community we talked about actually meets the state wide priorities for aged care. However, those facilities cannot be provided because withdrawal of services from the local hospital means that the application cannot meet the criteria required for Government funding for aged care facilities.

Now I want to look at a broader question. How are state wide priorities set?

Priorities begin with data. While data can be drawn from many sources, the census is the most readily available source. So agencies begin with census data and then crunch it in various ways.

To understand aged care needs, you begin with the population structures as revealed by the census. You then compare this with the existing distribution of aged care facilities. This gives a rough measure of relative needs, including relative gaps between needs and facilities.

You also need to know what is likely to happen in the future.

To do this, you generate projections based upon existing population structures and trends. You use these projections to create estimates of future needs. Comparing these to the current position helps you can decide where funding should go.

I am sure that all this sounds very reasonable, and at one level it is. However, there are problems.

To begin with, all taxpayers are entitled to get a return for their money. But what happens if you are in a low priority area such that the services you pay for are not in fact provided?

Nobody can ensure exact equivalence, nor is this necessarily sensible. However, some form of balance is equitable.

Then, too, the statistics themselves are uncertain. The aggregate numbers conceal considerable differences. A population pyramid may provide some guidance as to the numbers likely to enter the aged care system, but actually tell you very little about the exact pattern of services those people may require.

Finally, the approach adopted is mechanistic. It assumes that what was will be, the past determines the future.

Things change. If you base planning on the past and on projections based on that past, you are going to be wrong.

In my next column, I will extend my argument and then look at things that need to be done if we are to bring about change.

Note to readers: This post appeared as a column in the Armidale Express on Wednesday 14 July 2010. I am repeating the columns here with a lag because the Express columns are not on line. You can see all the columns by clicking here for 2009, here for 2010

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